21382例肝活检患者的慢性肝病谱及变化趋势

The chronic liver disease spectrum in 21 382 patients with liver biopsy

目的分析2007至2016年解放军总医院第五医学中心肝病谱的构成及变化趋势,为肝病管理提供循证依据。方法回顾性分析2007年1月至2016年12月住院行肝穿患者的临床资料,记录患者的性别、年龄、出院诊断、治疗转归等,分析10年来慢性肝病谱的变化趋势。结果共纳入肝穿患者21 382例,其中慢性乙型肝炎(CHB)、药物性肝损伤(DILI)、慢性丙型肝炎(CHC)、隐源性肝病(CID)、自身免疫性肝病(AILD)为前5位的病因。CHB以青年患者为主(62.0%);DILI以青、中年为主(47.7%、36.4%);CHC在60岁以下所占比例相似,少年、青年、中年分别为27.3%、36.9%、28.7%;CID以少年、青年为主(45.4%、36.1%),AILD以青、中年为主(33.1%、50.9%)。10年间CHB的构成比例从58.6%降至32.9%,DILI从7.4%上升至21.4%,CHC从7%上升至22.4%,后降至2.2%,CID从4.7%上升至32.9%,AILD从4.7%上升至7.7%。不同性别、各年龄区间呈不同的比例分布:CHB以男性为主,不同年龄区间构成比都高居首位,DILI、AILD均女性为主,尤其中年阶段;CHC患者男女比例相似,构成比在各年龄区间差距不大;CID以男性为主,青少年易患,构成比在少年、青年阶段接近。结论 CHB、CHC仍为目前肝病主要病因组成,其中DILI、AILD、CID逐年增加,CHB、CHC逐年下降,CHC受小分子药物影响尤为明显。

Objective To analyze the spectrum and trend of liver disease in our hospital, and to provide the evidence for chronic liver disease management. Methods The clinical data of inpatients with liver biopsy in our hospital from January 2007 to December 2016 were retrospectively analyzed. Results A total of 21382 patients with liver biopsy were enrolled and analyzed. In these cases, the top 5 etiologies were chronic hepatitis B (CHB), drug induced liver injury (DILI), chronic hepatitis C (CHC), cryptogenic liver disease (CLD), and autoimmune liver diseases (AILD). CHB mainly occurred in the young patients (62%). The majority of DILI was the young and middle-aged (47.7%, 36.4%). The proportions of the juvenile, young and middle-aged in CHC were similar (27.3%, 36.9%, 28.7%, respectively). The majority of CID was the juvenile and young (45.4%, 36.1%). AILD mainly occurred in the young and middle-aged (33.1%, 50.9%). In the past decade, the proportion of CHB in chronic liver disease decreased from 58.6% to 32.9%, while the proportion of DILI, CLD and AILD increased from 7.4% to 21.4%, 4.7% to 32.9% and 4.7% to 7.7%, respectively. The proportion of CHC increased from 7% to 22.4%, and then decreased to 2.2%. Moreover, the distributions differed in different gender and age groups. CHB mainly occurred in males, regardless of ages. However, DILI and AILD were more common in females, especially in middle age group. The constituent ratios of male and female in patients with CHC were similar. CLD mainly occurred in males and was more likely to occur in adolescents. Conclusion CHB and CHC are still the main causes of liver disease. However, the proportions of DILI, AILD and CID have increased rapidly, while the proportions of CHB and CHC have decreased significantly. Especially, the direct-acting antiviral therapy has achieved a great success in CHC.